Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

Jun 6, 2023Canadian journal of anaesthesia = Journal canadien d'anesthesie

Stomach content coming up during anesthesia in a fasting patient taking semaglutide for weight loss: a case report

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Abstract

A nondiabetic, nonobese patient taking the GLP-1 RA semaglutide experienced regurgitation of a large volume of gastric contents during anesthesia induction.

Semaglutide is associated with delayed gastric emptying and appetite suppression.
The patient had fasted for 20 hours for solids and eight hours for clear fluids before surgery.
Despite no traditional risk factors for regurgitation, the patient regurgitated gastric contents during anesthesia.
Patients using long-acting GLP-1 RAs like semaglutide may be at risk of pulmonary aspiration during anesthesia.
Recommendations include holding semaglutide four weeks prior to surgery and considering full stomach precautions.

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PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide are a class of medications prescribed to treat type 2 diabetes mellitus, and more recently, as an adjunct for weight loss because of its effects of delaying gastric emptying and suppressing appetite. Semaglutide is a long-acting agent with a half-life of approximately one week, and there are currently no guidelines that address the perioperative management of such agents.

CLINICAL FEATURES: We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA semaglutide for weight loss and had last taken the medication two days before their scheduled procedure.

CONCLUSIONS: Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.

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Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

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